Sarvesh Joshi

Facts You Need to Know About Leukemia (Blood Cancer)

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What is leukemia?

Leukemia is a cancer of blood-forming tissues which hinders the body’s ability to fight infection. It is caused by an increase in the number of white blood cells in the human body. These increased white blood cells sideline the platelets and the red blood cells that are required by the human body to be healthy.

Leukemia occurs as a result of malfunctioning of marrow leading to cancerous cell formation. These cells are found to overrun the normal blood cells interfering with the ability of the human body to control bleeding, deliver oxygen to normal working cells, and fight infections. The cancerous cells are known for invading the liver, spleen, and other organs.

What are the symptoms of leukemia?

Various symptoms of leukemia are visible in a patient, there is a possibility that not a single sign is visible in its early stage. However, some of the commonly found symptoms comprise fatigue, fever, bruising, chills, bleeding easily, joint pain, infections that keep returning back, headaches, seizures, vomiting, sweating at night, weight loss, swelling in lymph nodes, and shortness of breath.

What are the different types of leukemia?

Leukemia is classified by its speed of getting worse and by the blood cell type which is involved in it. By how fast it develops, leukemia is divided into acute and chronic leukemia. When maximum abnormal blood cells don’t mature and are not able to carry out normal functions, it’s considered acute leukemia. This type of leukemia has a tendency to get worse at an alarmingly increasing rate.

When a human body has a few immature cells while the other cells are working normally, this is termed chronic leukemia. It has a tendency to get worse at a slow rate. The other classification based on the type of blood cells consists of lymphocytic and myelogenous leukemia.

A lymphocytic or lymphoblastic leukemia comprises bone marrow cells that turn into a kind of white blood cell known as lymphocytes. Myelogenous or myeloid leukemia is one that involves marrow cells creating platelets, red blood cells, and various kinds of white blood cells.

Coming to types of leukemia, there are generally four types of leukemia, these are as follows – Acute lymphocytic leukemia, Acute myelogenous leukemia, Chronic lymphocytic leukemia, and chronic myelogenous leukemia. Let’s read about what these are.

ALL or Acute lymphocytic leukemia is a common form of leukemia found in children. This leukemia spreads to the central nervous system and lymph nodes. AML or Acute myelogenous leukemia is the second most common form of leukemia found in children. This one is most commonly found in adults.

Chronic lymphocytic leukemia or CLL has some kinds which are stable for years without any requirement for treatment. But in other kinds of leukemia, the human body is not able to create normal blood cells, and treatment is required.

Chronic myelogenous leukemia or CML doesn’t have any symptoms which are noticeable. A patient might not know that he/she is suffering from it until regular blood tests are run. This type of leukemia is most common in people who are aged 65 years and older.

What’s the difference between chronic and acute leukemia?

Chronic leukemia is one that progresses slowly and is not easily diagnosed until symptoms appear such as enlarged lymph nodes. This type of leukemia may be controlled by using chemotherapy, monoclonal antibodies, and corticosteroids.

The doctor may use transfusions such as platelet transfusions and blood transfusions for treatment. These treatments are used to decrease the platelets and red blood cells. Further, the radiations may help in reducing the size of the lymph nodes.

If you a patient is suffering from CML along with Philadelphia chromosome, the treatment given to you might be tyrosine kinase inhibitors (TKIs). These inhibitors block the protein and may also be used for stem cell therapy for replacing the cancerous bone marrow with a healthy one.

People suffering from Acute leukemia are quickly given treatment after the diagnosis is done. This is necessary because cancer may progress at a high rate. The treatments given in this type comprise targeted therapy, chemotherapy, or stem cell therapy which hugely depends on the type of acute leukemia.

The treatment given for acute leukemia is highly intense in the starting. Here, the main aim behind the treatment is to destroy the leukemia cells. There may or may not be any requirement for hospitalization. These types of treatments usually have side effects. Regular bone marrow and blood tests are run to examine the effect of this treatment on killing leukemia cells.

Various mixtures of drugs are used to see what works best in controlling the disease. In this, as soon as the blood returns to its normal state, leukemia goes into remission. However, a few tests will be conducted to see the chances of the return of the cancerous cell. Hope you now know the difference between chronic and acute leukemia.

How is leukemia diagnosed?

There are different types of leukemia that do not show any symptoms in the beginning phase, this is the reason that leukemia is diagnosed accidentally during a general physical exam. This exam may be a routine check-up or blood testing.

Doctors are required to check the symptoms present in the patient to ascertain that it is leukemia. Blood and bone marrow are checked for symptoms through various tests such as blood tests, bone marrow biopsy, spinal tap, and imaging tests.

Blood tests – A blood count or CBC is done to see the number and maturity level of various types of blood cells.

Bone Marrow Biopsy – In this test, the marrow is collected from the pelvic bone with the help of a long needle. This marrow sample when tested shows the kind of leukemia that the patient is suffering from along with its severity level.

Spinal Tap – Spinal tap comprises fluid collected from the spinal cord for examination. This test helps the doctors in knowing how much leukemia has spread inside the body.

Imaging Tests – In this, various scans are done such as CT, PET, and MRI that help in spotting the signs of leukemia.

Why are the tests expensive and are they really needed?

The doctors conduct the bone marrow test to find out the tissue and fluid in the marrow. The diagnosis test and treatment of leukemia are very expensive. An average treatment amount for six months in leukemia costs around 2.5 lacks; the drugs, tests, and treatment methods are rare and require high maintenance which makes it so costly.

These tests are essential as it helps in finding out if cancer has affected the blood cells or marrow. Along with this, it is done to find the extent of the disease. The marrow samples help in determining the blood cell changes even before they are seen in the blood sample itself.

A bone marrow test comprises of two steps which are a bone marrow biopsy and a bone marrow aspiration. The bone marrow aspiration is used for removing a liquid marrow sample while a bone marrow biopsy is used for the removal of a small amount of bone that is filled with marrow.

How is leukemia treated?

Due to the advancement in chemotherapy, people are surviving for a longer time as compared to the previous years. A huge success rate has been observed in childhood leukemia, there has been an increase in the five-year survival rate for children with ALL.

In the case of acute leukemia, the instant goal of treatment given is to reach remission. Patients are given chemotherapy in a hospital where they are required to stay to help them reduce infection. As the count of healthy blood cells is extremely low in the case of acute leukemia patients, they are given platelet transfusions and blood to assist in stopping and preventing bleeding.

In this condition, patients are given antibiotics for the prevention and treatment of infection. As the treatment given in cancer has side-effects, patients are put on medications to control these. In the case of acute leukemia, patients usually reach remission levels with the help of chemotherapy. This happens when chemotherapy is given as a primary treatment.

To control this disease further, consolidation chemotherapy is given to the patients for keeping the disease under control. This chemotherapy is given for 1-4 months to make the human body get rid of any malignant cells left. Patients diagnosed with ALL are generally given treatment for two years.

Even after complete remission, there are chances that patients suffering from acute myeloid leukemia may require a transplant of allogeneic stem cells. For this transplant, a donor is required who has compatible genetic characteristics and tissue type; in such cases, a family member is preferred. Any unrelated donor or umbilical blood are some of the other donor sources.

There are three stages of cell transplant which are induction, conditioning, and transplantation. Firstly, the white blood cells of the individual suffering are brought under control with the help of chemotherapy. A single dose of chemotherapy may be given to the patient before giving a conditioning regimen of a high dose of chemotherapy.

These therapies are given as they destroy the individual’s bone marrow or any residual leukemia cell that might be present. After this, the donor cells are infused. The patient is kept under observation until the donor marrow starts producing fresh blood cells.

This is necessary as, until the fresh production starts, the patient doesn’t virtually have any blood cells including red cells, white cells, or platelets. This situation may lead to the death of the suffered leading to bleeding or infection.

Once sufficient growth is observed in the donor stem cells in the bone marrow which generally happens in 2 to 6 weeks, a possibility of long-term remission arises. Additionally, chemotherapy is given to the patient who receives medication to treat and prevent graft versus host disease.

In such cases, the donor cells attack the patient’s normal tissue cells. Medical treatment is given to patients to prevent the rejection of the donor stem cells. The other treatment is allogeneic stem cell transplant which is not only expensive but also risky. The reason it is preferred by doctors is that it offers chances of best long-term remission in cases of high-risk AML and some cases of ALL.

In case, the treatments mentioned above don’t show any positive results in children or young adults suffering from B-cell type ALL or if cancer comes back then the doctors may want to try a new kind of treatment which is comprises gene therapy.

By using CART-cell therapy, some immune cells may be reprogrammed so that the cancer is attacked. There are severe side-effects of these treatments, therefore only some of the hospitals and clinics are given the certification to do this treatment.

The other form of leukemia is chronic lymphocytic leukemia or CLL which is a form that generally affects people of older age. This type of cancer is known for its slow progress and thus the procedure used for its treatment may be conservative.

Not all patients suffering from leukemia require treatment immediately. The ones who need treatment are those who show symptoms that require treatment including the ‘so’ called ‘B’ symptoms of night sweats for 14 consecutive days, fever, or 10% sudden weight loss in six months which is unintentional.

Symptoms other than mentioned above which require treatment are swollen lymph glands, evidence of the failure of bone marrow, and painful swelling in the spleen or liver. One of the treatments of leukemia is oral chemotherapy which is known for effectively controlling the symptoms of CML for many years.

Many cases of CML in the past years have eventually advanced to acute phases even after the treatment was provided. This is the reason that doctors advise bone marrow transplantation in the chronic phase.

Allogeneic stem cell transplantation for CML is one of the treatments which is considered for disease resistance to the treatment of patients in whom the disease has reached the acute phase. There is the drug imatinib or Gleevec which is considered as a radically changed treatment for CML. This is known as a molecular targeting drug as it attacks the genetic alterations that are known for causing white blood cells for out-of-control growth.

Gleevec when given to the patients doesn’t cure CML but may lead to long-term remission and survival of CML. The results provided by this drug have made it superior to the other therapies which were used priorly such as interferon-alpha, hydroxyurea, and busulfan.

There are four drugs comprising bosutinib, nilotinib, ponatinib, and dasatinib which may be used in CML in case leukemia becomes resistant to Gleevec. Nilotinib or Tasigna is FDA approved for its usage in the treatment of CML in the chronic phase.

Dasatinib or Sprycel is another FDA-approved drug that is used for first-line therapy given during the chronic phase of CML. Bosutinib or Bosulif and Iclusig or ponatinib may be used during various phases of CML, this is possible if the patient cannot tolerate or is resistant to various other drugs.

The other drug known as omacetaxine mepesuccinate or Synribo is a drug that is approved for use by those in whom the CML has progressed. This progression must be after treatment of two or more medications have been given to the sufferer.

Why do people with same cancer get different treatments and have different problems?

Patients suffering from the same cancer may or may not receive the same treatment. Several tests are done before ascertaining the treatment to be given to a patient. The treatment chosen depends on the severity of leukemia, its growth, and the patient’s body’s ability to respond to a particular type of treatment.

There is a possibility that one type of medication may show positive recovery results in one patient while showing no sign in the other. In such cases, different treatments are given to different patients.

Every human body is unique in some way and may or may not respond to a situation in the same way as others. This is the reason that people suffer from different problems owing to their family’s medical history, genes, and current medical situations that they might be facing.

Can a change in diet or lifestyle alter the course of cancer? Can the so-called superfoods available in the market cure cancer?

Cancer is a result of genetic damage caused to cells, this is why it cannot be cured by any change in diet or eating the so-called superfood available in the market. A change in lifestyle may help in preventing cancer but once diagnosed, no lifestyle change can cure it.

Can blood cancer be cured?

The curability rate of blood cancer is observed to be a little high; with the help of the right treatment and medicines, many patients have got rid of cancer. Many years of research have shown that the chance of survival has improved when it comes to patients suffering from blood cancer.

Reports by the National Institutes of Health state that two-third of people who were diagnosed with leukemia may live up to five years or more. When it comes to Hodgkin and non-Hodgkin lymphoma, the curability rate is 85 percent and 70 percent.

Are the side effects of chemotherapy worse than cancer?

When a patient is going through the treatment of cancer, simultaneously he is also given medication for controlling the side effects caused as a result of treatment. Side effects caused during the treatment procedure can be cured and prevented with the help of drugs and therapies. These side effects are generally temporary and end once the treatment is completed.

Can leukemia be prevented?

There is no way to prevent leukemia as such. However, one may avoid tobacco and exposure to various industrial chemicals and pesticides as a precaution.

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Glaucoma: Causes, Types, Symptoms, Diagnosis, and Treatment

Leave a Comment / Health and Tips / Sarvesh Joshi

Glaucoma is an eye disease that is related to eye disorders. Let’s have a look at a brief description of glaucoma, its types, causes, symptoms, diagnosis, and treatment.

What is Glaucoma?

Glaucoma is related to eye problems. It’s generally a group of eye disorders, it is a complex disease that can damage the optic nerve and can lead to loss of vision. In most cases of glaucoma, fluid material builds up in the front part of the eye. Then this extra fluid puts pressure on the eye, which sends images to your brain. If the damage worsens, it gradually damages the optic nerve. This pressure is called IOP which means intraocular pressure, or eye pressure.

In some cases, people have normal eye pressure and still get glaucoma. Untreated or poorly controlled glaucoma can lead to irreversible and permanent vision loss or even total blindness within a few years.

Most people with glaucoma don’t show early symptoms or any pain. It’s a good habit to visit your ophthalmologist regularly so that they can diagnose and treat glaucoma before you have long-term vision loss.

If you lose vision due to any disorder, it can’t be brought back. But if you have lowering eye pressure then they can help you to keep the sight you have. Most people with glaucoma who follow their treatment plan and have regular eye check-ups can keep their vision.

What are the Types of Glaucoma?

There are various types of glaucoma. Each type of glaucoma is different from the others, but most of them have no early symptoms or no post symptoms, so it’s important to get tested regularly, especially if you are at higher risk.

Primary Glaucomas:

When the doctors are unable to find out which causes a type of glaucoma, that type is called primary glaucoma.

Open-angle glaucoma: Open-angle glaucoma is the most common type of glaucoma according to the National Eye Institute (NEI). It can be called chronic or primary glaucoma also. It doesn’t show any signs or symptoms except gradual vision loss over time. The vision loss may be so slow that your vision may suffer irreparable damage.

- Treatments: Laser treatment, surgery, medicines

Normal-tension glaucoma: It is also known as low-pressure glaucoma. It is also a rare type of glaucoma in which you have blind spots in your vision and your eye pressure isn’t above the normal range but still causes damage to the eye that affects the optic nerve. Many experts believe that this too is like open-angle glaucoma.

- Treatments: Laser treatment, surgery, medicines

Angle-closure glaucoma: It is also called narrow-angle glaucoma or acute angle glaucoma. In this sort of glaucoma, the fringes of the iris (the colored part of your eye) block fluid from draining out of the front of the eye. The fluid builds up quickly, causing an increase in eye pressure. If it’s not treated, acute glaucoma can cause blindness in only a couple of days.

- Treatments: Laser treatment, medicines

Congenital glaucoma: Congenital glaucoma is not common it is a very rare inherited condition almost 1 in 10,000, that develops due to the incomplete or faulty development of the drainage canals of the eye. It’s mainly a type of disease that occurs in infants and young children due to abnormal development of the drainage angle of the eye. It encompasses a heterogeneous group of diseases.

- Treatments: Surgery, medicines

Secondary Glaucomas:

Many times glaucoma is caused by some other medical condition then this is called secondary glaucoma.

Neovascular glaucoma: Neovascular glaucoma occurs when the eye makes extra blood vessels that cover the part of your eye where fluid would normally drain out. It’s mainly caused by another medical condition, like diabetes or high blood pressure. This kind of glaucoma is hard to treat. Doctors firstly have to treat the underlying cause (like diabetes or high blood pressure) and then use glaucoma treatments to lower the eye pressure that results from it.

- Treatments: Laser treatment, surgery, medicines

Pigmentary glaucoma: Pigment dispersion syndrome or pigmentary glaucoma happens when the color from your iris (the colored part of your eye) flakes off. This loose pigment can block the fluid from draining out of your eye, which may further increase your eye pressure and can cause pigmentary glaucoma. Doctors may treat it by lowering the eye pressure, but it isn’t a proper way to prevent pigment from detaching from the iris.

- Treatments: Laser treatment, surgery, medicines

Exfoliation glaucoma: Exfoliation glaucoma or may be called pseudoexfoliation glaucoma happens in those people most of the time who having exfoliation syndrome, a condition that causes extra material to detach from parts of the eye and block fluid from draining out. This kind of glaucoma can progress faster than primary chronic glaucoma or open-angle glaucoma and sometimes causes higher eye pressure. This means that it is very important for people that are at risk to get eye check-ups regularly.

- Treatments: Laser treatment, surgery, medicines

Uveitic glaucoma: Uveitic glaucoma can happen in those people who have uveitis, a disorder type that causes irritation and swelling in the eye. About 2 in 10 people with uveitis disease will develop uveitic glaucoma. Uveitis can cause inflammation and connective tissue in the middle of the eye. This might damage or block the part of the eye where fluid drains out, causing high eye pressure and resulting in uveitic glaucoma.

- Treatments: Surgery, medicines

What are the causes of Glaucoma?

The back part of the eye continuously makes a transparent fluid which is called aqueous humor. As this fluid is formed, it fills the front part of your eye. Then, it leaves the part through the channels in the cornea and iris. If these channels are blocked or partially obstructed, it puts the natural pressure in your eye, which is named intraocular pressure (IOP), may increase. As your intraocular pressure increases, it may have the chance to damage your optic nerve. As damage to your nerve progresses, you’ll begin losing sight of your eye.

Abnormally high pressure within the eye i.e. intraocular pressure is sometimes higher, but not always, associated with optic nerve damage. When the pressure inside the eye increases this is due to the eye’s fluid drainage system fails to function properly.

Chronic glaucoma or open-angle glaucoma – In this, the blockage of the eye’s drainage channels occurs gradually. It’s the foremost common form and is painless
Acute angle glaucoma – In this, the blockage in the drainage channels of the eye occurs suddenly. It’s painful and may end in permanent vision loss if not treated immediately.

There are different kinds of glaucoma, with a variety of characteristics and causes. Some of these include:

Primary chronic glaucoma – a partial blockage in the eye’s drainage system causes fluid to drain out of the eye too slowly, resulting in a gradual increase in pressure within the eye
Angle-closure glaucoma or Narrow-angle glaucoma– In this type, glaucoma occurs when the iris bulges and blocks the drainage system, causing inadequate fluid drainage and an increase in intraocular pressure
Normal-tension glaucoma – the optic nerve becomes damaged although the pressure within the eye remains normal. The reason is unclear but could be due to a scarcity of blood flow to the optic nerve.
Congenital glaucoma – this occurs in infants and children and usually without symptoms
Pigmentary glaucoma – pigment granules within the eye build up and block drainage channels.

Glaucoma tends to run in families. Recent studies have found sort of genetic variations in human DNA that each contribute a small amount to intraocular pressure and which could predict whether someone might develop glaucoma with 75% accuracy.

What are the glaucoma symptoms?

Both Open-Angle Glaucoma and Acute Angle-Closure glaucoma have completely different symptoms. Symptoms of glaucoma are:

Symptoms of Open-Angle Glaucoma: The various symptoms of open-angle glaucoma include-

Peripheral vision, usually in both eyes, is lost gradually (characterized by the development of patchy blind spots)
- Advanced stages are characterized by tunnel vision.

Symptoms of Acute Angle-Closure Glaucoma: The various symptoms of acute angle glaucoma include –

Pain in the eye, which may be accompanied by nausea and vomiting
- Sudden development of visual disturbance
- Blurred vision
- Seen Halos (i.e. crowns or auras) lights
- Reddening of the eye
- Severe headaches
- Unexpected vision problems, especially in poor lighting.

Regular eye checkups are very important to detect glaucoma in the early stages to successfully treat it and prevent further progression.

How is glaucoma diagnosed?

Glaucoma can be diagnosed by regular eye checkups. If it can be diagnosed early then glaucoma can be properly managed to prevent major loss. Here are the 6 steps used to help detect glaucoma.

Tonometry: Tonometry is a common test used to measure the pressure inside the eye which is intraocular pressure (IOP). It is a measurement of determining whether you have glaucoma or not. Or it is not treated in time, it will lead to vision loss.

Ophthalmoscopy: Ophthalmoscopy is a diagnostic test that is used to examine the inside of the eye. Ophthalmoscopy is performed on a dilated or undilated eye. an eye doctor uses special magnifying lenses and medical devices to look at the optic nerve. The color, shape, and overall health of the optic nerve are vital in glaucoma assessment. The doctor can also use a photographic camera to photograph the optic nerve.

Gonioscopy: Gonioscopy is also a diagnostic test that uses a special mirrored device to gently touch the surface of the eye to look at the angle where the cornea meets the iris. Whether this angle is open or closed can tell the doctor what sort of glaucoma is present, and the way severe glaucoma could also be. Gonioscopy can also be done by using optical coherence tomography.

Visual Field Testing: It is also known as perimetry, is a test that is used to diagnose glaucoma that measures how sensitive a person’s vision is. In perimetry or visual field test, you’ll look straight ahead at a small light or any target and you will be asked to let the examiner know once you see a flashlight to the side in your sight. Visual field testing usually must be repeated several times before the doctor can make a valid assessment

Nerve Fiber Analysis: Nerve fiber analysis is a newer method of glaucoma testing during which the thickness of the nerve fiber layer is measured. Thinner areas of the eye may indicate damage caused by glaucoma. This test is especially good for those patients who may be considered to be a glaucoma suspect and also to point out if a person’s glaucoma is progressively becoming worse.

Pachymetry: Pachymetry is another test method used to measure the thickness of the cornea. Pachymetry is starting to play a huge role in glaucoma testing The thickness of the cornea seems to influence the pressure reading when tonometry is performed.

What is the treatment of Glaucoma?

Your treatment will largely depend upon the type of glaucoma you have. The most common type, primary open-angle glaucoma, is usually treated with eye drops. Laser treatment or surgery could also be offered if drops don’t help. Glaucoma treatment includes:

Medication or Eye drops: Medicines or eye drops are given in the treatment for glaucoma. Eye drops are prescribed to use 1 and 4 times every day. It is vital to use them as directed, although you haven’t noticed any problems with your vision. Your eyesight is at risk if you do not stick or follow the recommended treatment.

Laser treatment: Laser treatment is recommended when eye drops don’t work or improve your symptoms. This is where a high-energy beam of light is carefully aimed toward a part of your eye to prevent fluid from building up inside it. There are various laser treatments are available that includes:

Laser Trabeculoplasty: The eye surgeon uses a laser in this treatment to make the drainage angle work better. In that way, fluid flows out properly into the eye and hence eye pressure is reduced.
Cyclodiode Laser Treatment: In this treatment, the ophthalmologist uses a laser to lower the eye pressure drainage of a fluid called aqueous humor.
Laser Iridotomy: In this treatment, the ophthalmologist uses a laser beam to create a tiny hole in the iris. This hole helps fluid flow to the drainage.

Surgery: Surgery is recommended when the medicines and laser treatment haven’t been effective. The most common form of surgery for glaucoma is named trabeculectomy. It involves removing a part of the eye-drainage tubes to allow fluid to drain more easily. Glaucoma surgery could also be carried out under local anesthetic that means while you’re awake or general anesthetic when you’re asleep.

FAQ (Frequently Asked Question):

Q. What are the risk factors?

Ans. There are so many risk factors few of them are:

Having high eye pressure is also called intraocular pressure.
Over the age of 60.
Having certain medical problems such as diabetes, high blood pressure, heart disease, etc.
Having a family history of glaucoma.

Q. Is glaucoma preventable?

Ans. Glaucoma is not curable. As with any vision, blindness that is lost can not be brought back but glaucoma can be prevented if it is diagnosed in the early stage.

Q. Is it possible to become blind with glaucoma?

Ans. Yes, sometimes glaucoma can cause blindness also but it is very rare, about 5% of glaucoma patients become blind. However, sight impairment is common and occurs in almost 10% of glaucoma patients.

Q. Can glaucoma be cured?

Ans. Glaucoma can be cured if it is recognized in the early stages, otherwise, treatment and regular checkups can help to slow down or prevent vision loss but the damage caused by glaucoma can not be reversed. It is treated by lowering the eye pressure i.e. lowering the intraocular pressure.

Q. If I am diagnosed with glaucoma, how often should I go for an eye check-up?

Ans. A normal person should go for eye check-ups once or twice in 2 years. But the glaucoma patients should go for regular eye check-ups of a minimum of twice a year. You should do a visual field test at least once every 12 months, and some assessment of your optic nerve health at least once every 12 months.

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